Advise patients to use tick checks, DEET, and showers to avoid tick bites; if a tick is attached, it should be removed promptly and safely.

Ask patients with suggestive symptoms such as fever, headache, malaise, and/or rash about travel history, as most tick-borne infections are acquired outside of New York City.

Follow recommended testing protocols, including repeat testing if indicated, because symptoms may be nonspecific and immune response is often delayed.

NATURAL HISTORY

Most ticks go through 4 life stages: egg, 6-legged larva, 8-legged nymph, and adult, and must eat blood at every stage after egg. Ticks will attach to a host (usually small mammals such as the white-footed mouse) and suck the blood slowly for several days. If the host has a bloodborne infection, the tick will ingest the pathogens with the blood. At the next feeding, the tick can potentially transmit the disease when attaching to a person, pet, or other animal.1,2